Tianeptine (INN) (Stablon, Coaxil, Tatinol) is a drug used for treating major depressive episodes (mild, moderate, or severe). It has structural similarities to the tricyclic antidepressants, but it has different pharmacological properties. Until recently, it has been assumed that tianeptine is a selective serotonin reuptake enhancer (SSRE), opposite to the action of SSRIs. However, newer studies question this hypothesis; one review suggests that long-term administration of tianeptine has no effect on serotonin pathways, while another still points to the cancellative effects of tianeptine and fluoxetine coadministration on serotonin reuptake. Tianeptine enhances the extracellular concentration of dopamine in the nucleus accumbens and modulates the D2 and D3 dopamine receptors, but this effect is modest and almost certainly indirect. There is also action on the NMDA and AMPA receptors. Recent reviews point to this pathway as a hypothesized mechanism of action, based on tianeptine's effect of promoting stress-associated impaired neuroplasticity.
Tianeptine reduces the effects of serotonin in the limbic system and the pre-frontal cortex, giving rise to a mood elevation, unlike the mood blunting associated with SSRIs.[citation needed] Like SSRIs, however, tianeptine's onset-of-action delay is approximately 2–6 weeks with improvements sometimes noticeable in as soon as one week. Its short-lived, but pleasant, stimulant effect experienced by some patients is shared with its predecessor, amineptine, whose side effects related to dopamine uptake inhibitor activity resulted in Servier's research into tianeptine.[citation needed] Suggested dosage is three times daily, due to its short duration of action.
Tianeptine has strong antidepressant and anxiolytic properties with a relative lack of sedative, anticholinergic and cardiovascular adverse effects, thus suggesting it is particularly suitable for use in elderly patients and in those following alcohol withdrawal; such patients can be more sensitive to the adverse effects of psychotropic drugs. Recent interesting results indicate anticonvulsant and analgesic activity of tianeptine and its possible interaction with adenosine A1 receptors.
Mechanism of action
In contrast to SSRIs and tricyclic antidepressants, tianeptine modestly enhances the mesolimbic release of dopamine, but it is also unclear how this occurs because tiapentine itself has no effect on dopamine transporters, nor does it affect D1, D2, D3, D4 and D5 receptors.
Perhaps the most studied hypothesis is that Tianeptine has a protective effect against stress induced neuronal remodeling. This is all based largely on preclinical studies.
Abuse and addiction potential
One patient reportedly consumed a total of 240 12.5 mg tablets (3000 mg) per day for several months and was later successfully detoxified in an inpatient setting. The report indicated that a tolerance was developed and there were physical withdrawal symptoms.
In 2007, according to French Health Products Safety Agency, tianeptine's manufacturer Servier agreed to modify the drug's label, following problems with dependency.
Singapore's Ministry of Health has restricted the use of tianeptine to psychiatrists due to its abuse potential, while Bahrain has classified it a controlled substance due to increasing reports of misuse and abuse by patients.
Tianeptine (under "Coaxil" brand name) has been intravenously injected by drug users in Armenia and Russia. This method of administration reportedly causes an opioid-like effect and is sometimes used in an attempt to lessen opioid withdrawal symptoms. As tianeptine tablets do not fully dissolve and often the solution is not filtered well, particles in the injected fluid can block small blood vessels, leading to thrombosis and then severe necrosis.
Approved
Investigational and ongoing research
It is currently being researched for its effectiveness in irritable bowel syndrome.
Tinaneptine has been found to be effective in depression in Parkinson's disease and in post-traumatic stress disorder of which it was as safe and effective as fluoxetine (Prozac, an SSRI) and moclobemide (Aurorix, an MAO-A inhibitor).